AB0458 DISEASE ACTIVITY AT CONCEPTION PREDICTS LUPUS FLARE UP TO 2 YEARS AFTER BIRTH: A MULTICENTRE LONG TERM FOLLOW-UP STUDY
Authors: M. Radin, K. Schreiber, I. Cecchi, F. Signorelli, G. De Jesùs, K. Aso, M. Kono, M. L. Urban, B. Bacco, S. Gallo Cassarino, L. Lo Sardo, S. G. Foddai, A. Barinotti, I. Gómez García, M. I. Quaglia, Y. Tissera, F. Gervasoni, M. Á. Aguirre-Zamorano, P. Alba, C. Benedetto, T. Atsumi, O. Amengual, G. Emmi, D. Andrade, L. Marozio, D. Roccatello, S. Sciascia
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic lupus erythematosus (SLE) often affects women in their childbearing years, and pregnancy may affect SLE disease activity during pregnancy and post-partum (1,2). Limited data assessing the likelihood and characteristics of SLE activity in an extended time period post-partum which may be relevant as patients may wish further pregnancies exist. Objectives To assess predicting factors that might influence SLE disease activity in women in an extended follow-up period of 2 years after giving birth and clinical assessment every three months. Methods The study was design as an international retrospective, data-driven case collection study, enrolling 119 women with a first birth and with a strictly monitored follow-up period of 2 years. Results Table 1 shows pregnancy outcomes of all pregnancies. When considering disease manifestations, joint involvement was present in 80% of patients, acute cutaneous in 64%, haematological in 54%and renal in 41%; 75% of patients were positive for anti-dsDNA, 49% for anti-ENA and 37% for anti-Ro/SSA positive. The mean SLE disease activity index 2000(SLEDAI-2k) at diagnosis was 13.5±6.8 and at first birth was 2.8±4.4. Table 1. Pregnancy outcomes of all pregnancies and relative breastfeeding data Pregnancy Characteristics All (214) % Outcomes Live births 169 79 Miscarriages 37 17.3 Stillbirths 8 3.7 Maternal and Foetal Complications Prematurity 39 18.2 Pre-eclampsia 23 10.7 HELLP syndrome 4 1.9 Placental Infarction 12 5.6 Breastfeeding (all pregnancies) Any breastfeeding (n, %) 109 64.5* Exclusive breastfeeding (n, %) 87 51.5* Breastfeeding (after first birth) Any breastfeeding (n, %) 87 73.1** Any breastfeeding duration (months) (m±sd) 10.29±10.04 Exclusive breastfeeding*** (n, %) 62 52.1** Exclusive breastfeeding*** duration (months) (m±sd) 6.07±6 *Percentages are calculated considering viable babies (total= 169 ) **Percentages are calculated considering first birth (total= 119 ) ***Exclusive breastfeeding was defined as feeding infants only breast milk At follow-up, 51.3% of patients had at least one flare after a mean time after birth of 9±6.3 months(mean flare per patient 0.94±1.1). The most frequent flare manifestations were joint involvement(48%), followed by renal(33%), cutaneous(28%) and haematologic(20%). Patients with remission of disease(SLEDAI-2K=0; no clinical or laboratory manifestations of SLE) at conception had significantly lower rates of flares than those not in remission (18/49–37% vs. 43/70–61%;p=0.008) (Figure 1). Figure 1. Flare proportion: Survival Curve based on remission status at conception of the patients included in the study. Patients who experienced a flare during pregnancy (17 patients), when compared to those who did not, had higher rates of flares during follow-up (76% vs. 47%, respectively, p=0.019), lower time for first flare (4.4±2.3 months vs. 10.3±6.5, respectively, p&lt;0.001), lower rate of remission of disease at conception (12% vs. 46%, respectively, p&lt;0.001), lower rates of SLEDAI 2K at conception (5.9±5.6 vs. 2.3±4, respectively, p&lt;0.001) and lower rates of exclusive breastfeeding (24% vs. 57%, respectively, p=0.009). Remission of disease and flares during pregnancy remained significantly associated with the development of flares during follow-up after multivariate analysis. Conclusion Remission at conception can influence SLE disease positively, even at long-term. Planned pregnancy counseling is fundamental when managing SLE patients. References [1]Tincani A, Nalli C, Khizroeva J, Bitsadze V, Lojacono A, Andreoli L, et al. Autoimmune diseases and pregnancy. Best Pract Res Clin Endocrinol Metab 2019;33. [2]Clowse MEB, Magder LS, Witter F, Petri M. The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum 2005;52:514–521. Disclosure of Interests None declared